Public Health

Paul Offit at the Philadelphia Neurological Society

Paul A. Offit, MD On October 12, the Philadelphia Neurological Society held one of its regular meetings at The College of Physicians of Philadelphia and invited Paul A. Offit, MD, to speak to the membership. Offit, chief of infectious diseases at The Children’s Hospital of Philadelphia (CHOP), vaccine developer, and advisor to The History of Vaccines, greeted the membership with his first slide and title of his talk: “Why are neurologists scared of vaccines?”  Though Offit’s title was tongue-in-cheek, it spoke to a tension he has perceived between neurology and vaccinology. More

World Rabies Day: Rabies Vaccines

Semple Rabies Vaccine, The College of Physicians of Philadelphia In honor of World Rabies Day, we’d like to draw attention to two rabies vaccines recently found in the collection of the Mütter Museum of The College of Physicians of Philadelphia. Museum curator Anna Dhody recently alerted us to a box of vaccines and other medical supplies she found in a little-visited storage area in the museum basement. The box belonged to a collection of medical equipment donated by James G. Kitchen II, MD (d. 1998), who was a Pocono Lake, Pennsylvania, physician and fellow of The College of Physicians of Philadelphia. Dr. Kitchen stocked the vaccine in his office supplies to address what was probably a fairly uncommon need in his practice: post-exposure rabies prophylaxis in humans. More

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An Infectious Diseases Doctor Views Contagion

1918 Influenza Scrapbook, The College of Physicians of Philadelphia Going to the movies is a time-honored way of getting away from the vagaries of work and home life and inhabiting a different and exotic place. I don’t know if car mechanics can really enjoy chase movies or cowboys can appreciate Westerns, but as a specialist in Infectious Diseases, I rarely get a chance to see someone plying my trade inside the multiplex. There are spoilers ahead, so read on cautiously if you have not yet seen Contagion and plan to go.

The new Steven Soderbergh movie, Contagion, is a fairly realistic guesstimate of what might happen if a highly contagious, new infectious agent started moving around the world and destroying people willy nilly like a marauding tornado. While there has never been an infection quite like “MEV-1” as depicted in Contagion, the question of how we would respond as a medical community and as a society is a worthy one to address. Whether the answer is right or wrong – well, let’s hope we never find out.

From an Infectious Diseases angle, the infection in Contagion is crafted to be highly transmissible and fatal. This would be like a hybrid of the 1918-1919 pandemic flu, Nipah virus and SARS. The end of the movie shows the mechanism via which MEV-1 began to infect humans, and it is highly reminiscent of Nipah and SARS. Thus has some built-in credibility as it builds on diseases that we already understand. It is also eerily reminiscent of the most recent big flu outbreak (A/California/2009 H1N1) where the virus contained elements that came from birds, pigs and people. The rapidity of spread lends the movie much of its terror, but is not far off the rapidity of spread of influenza. Similarly, the incubation period and time to death is also reminiscent of the 1918-1919 pandemic flu. So the film-makers have done their homework and created a plausible disaster scenario. More

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Early Evidence of Virus Behind 1918 Flu Pandemic

1918 Influenza Scrapbook, The College of Physicians of Philadelphia The so-called Spanish influenza pandemic of 1918 was one of the worst natural disasters in history. Estimates of total death counts vary, but it is commonly stated that the virus infected about one-third of the world’s population and killed about 50 million – possibly as many as 100 million. Researchers have long been interested in learning more about the virus and what made it so deadly, and genetic analysis has been a large part of that effort. In 2005 the full genome sequence of the virus was published, and research has continued from that point.

The virus behind the 1918 pandemic was an H1N1 strain; in fact, it was the only H1N1 strain to cause a pandemic in the 20th century. (Pandemics that began in China in 1956 and Hong Kong in 1968 were caused by H2N2 and H3N2 strains, respectively.) It was unusually severe, and in an unexpected result for an influenza virus, tended to kill healthy young adults rather than the typical flu victims – the very old and the very young. This contributed to the initial fear when novel H1N1 appeared in 2009, particularly since the number of deaths per age group early in the outbreak skewed heavily toward young adults. More

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Vaccine Meetings Discuss Challenges, Achievements

Two important vaccine meetings were held September 11 and 12 at The College of Physicians of Philadelphia. The September 12 meeting entitled Research Integrity Challenges in Vaccine Development and Distribution for Public Health Emergencies was sponsored by the Department of Health and Human Services, the Office of Research Integrity, Drexel University, University of Pennsylvania Center for Bioethics, and The College of Physicians of Philadelphia. Speakers focused on vaccine development and distribution for biological threats and how the emergency preparedness experiences with A/H1N1 provided lessons that might inform future preparation for similar public health emergencies. More

HPV Vaccine Protects Against Anal Infection

Immunization record showing full HPV vaccination Human papillomavirus (HPV) is primarily known for its role in causing cervical cancer. Two strains of the virus – strains 16 and 18 – are estimated to be responsible for 70% of cervical cancer cases, leading to about 500,000 new cases and 270,000 deaths worldwide each year.

Both of the HPV vaccines available in the United States have been shown to be effective in preventing cervical infection with strains 16 and 18. The Gardasil quadrivalent vaccine also offers protection against two strains that cause genital warts. But HPV’s role in cancer is not limited to cervical cancer; the virus can also cause oral, anal, and penile cancer. More

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Philadelphia Vaccine Meetings 9/12 and 9/13

The College of Physicians of Philadelphia Two important vaccine meetings are being held at The College of Physicians of Philadelphia. The first meeting occurs September 12, and is entitled Research Integrity Challenges in Vaccine Development and Distribution for Public Health Emergencies. Sponsors include the Department of Health and Human Services, the Office of Research Integrity, Drexel University, University of Pennsylvania Center for Bioethics, and The College of Physicians of Philadelphia. The second meeting on September 13 is part of the National Vaccine Program Office's effort to gather stakeholder input. Regional stakeholders are invited to attend sessions and share their experiences with immunization, particularly around racial and ethnic disparities, risk communications, and adolescent and adult vaccines. The information gathered at this meeting will help guide the implementation of the National Vaccine Plan as well as inform local and regional vaccine groups on barriers and successes in immunization. More

FDA Approves Tetanus, Diphtheria, Pertussis Booster For Adults 65+

This photomicrograph shows Bordetella pertussis bacteria using Gram stain technique. Credit: CDC. In October 2010, the Advisory Committee on Immunization Practices (ACIP) issued a new recommendation for Tdap vaccination -- the booster vaccine that provides protection against tetanus, diphtheria, and pertussis (whooping cough). While the vaccine had previously been recommended as a one-time booster for adults up to age 64, replacing an individual tetanus booster, the committee voted to expand that recommendation: anyone older than 65 who had not received a prior dose of Tdap should receive one if they expected to have close contact with an infant younger than 12 months old.

This recommendation was made partially in light of the California whooping cough epidemic. While whooping cough is typically less severe in adults, the infection can still be passed to infants, for whom infections are much more severe. Study data has indicated that grandparents, for example, are the ultimate source of the infection in 6-8% of cases. However, the committee noted that there was a direct benefit to the individual as well, since whooping cough tends to be more severe in adults older than 65 than in younger adults. (For more details, see "Advisory Committee Votes for Expanded Pertussis Vaccine Recommendations" from the History of Vaccines blog.)

Although this recommendation was issued last October, some adults older than 65 who wanted to receive a Tdap booster had difficulties obtaining one due to confusion between the ACIP's recommendation and the FDA's approved label usage for the vaccine at the time. Neither of the two Tdap vaccines (Sanofi Pasteur's Adacel and GlaxoSmithKline's Boostrix) was approved by the FDA for use in adults older than 65. More

Research May Provide New Possibilities for Universal Influenza Vaccine

Influenza A virus, transmission electron microscopy, 31,710x. Copyright Dennis Kunkel Microscopy, Inc. Each year, researchers select three influenza strains to include in the seasonal flu vaccine. Because there are so many different strains of the influenza virus, and because it mutates so rapidly, this selection is always a guess—a highly educated one based on global surveillance data, but still a guess.

In some years, the selections turn out to be remarkably accurate. During the 2010-2011 flu season, for example, the three strains selected for the seasonal flu vaccine were a very good match to strains circulating in the wild. In other years, however, researchers haven’t been so lucky. And since immunity to one strain of the flu doesn’t necessarily provide protection against other strains, a poor match between the vaccine strains and the circulating ones may mean an ineffective flu vaccine.

Researchers have long hoped to develop a so-called “universal” flu vaccine: one that could provide protection against all, or at least most, of the many strains of influenza capable of making people sick. If such a vaccine could be developed, the need for a new seasonal shot every year could be a thing of the past. More

Pacific Health Summit: June 21-23

HOV at Pacific Health Summit Just a week after a June 13 summit at which public and private donors committed $4.3 billion to continue funding the GAVI Alliance’s efforts to immunize the world’s poorest children, another vaccines summit played out in Seattle. The Pacific Health Summit, a yearly conference examining a different global health issue, convened June 21-23 with the goal of connecting decision makers in science, industry, policy, and public health to improve health by combining the latest in scientific advances with industrial innovation and effective policy. Past topics have included multi-drug resistant tuberculosis, maternal and child health, malnutrition, and pandemic influenza. More